The Shawnee County Health Agency is looking into separating its primary care services from under the county and becoming a private nonprofit.

The idea comes from a commissioned Safety Net Report, which analyzed services of the health agency and Marian Clinic. It was completed in January by Millennia Consulting.

“In view of evidence that the public entity model does not appear to be successful in Topeka, we recommend that the County Commissioners and the consumer Board consider the 501(c)(3) option,” the report notes.

The report has contributed to the delay in relocating the health agency’s primary clinic, after it sold to Stormont-Vail HealthCare two years ago. An extended lease, scheduled to come before the Shawnee County Commission on Monday, would cost the county $20,330.79 per month.

Under the current suggestion, the Local Health Department would remain under Shawnee County.

Transitioning the agency’s FQHC services into a nonprofit was the top recommendation of the report, which aimed to help Shawnee County fill the gap of uninsured residents who aren’t served by current safety net clinics. The data compiled by the firm show 15,860 of the county’s uninsured don’t have regular source for medical, dental and/or behavioral health. At the same time, Shawnee County has the highest cost per patient and a high number of support staff.

The FQHC currently receives $2.4 million from Shawnee County taxpayer dollars — less than half of its $5.8 million budget.

As a county department, Shawnee County’s health agency operates its federally qualified health center, which offers primary care services, under the public-entity model. As such, it is the only one in Kansas and among just 5 percent of FQHCs in the nation.

“This is a very exciting opportunity for the community,” said Alice Weingartner, community health center director. “This is an opportunity for us as a community to look at new ways we can serve our community better.”

However, she said, the agency is “far, far away” from making a decision. The agency isn’t even to the point to discuss when a decision would be made, let alone what the effect on its 70 FQHC employees would be.

A project manager will be on scene by the end of May to help address those questions and timelines, she said.

“This is the very first step of a long process,” Weingartner said. “It’s scary, and it causes anxiety, but ultimately we will be in a really good place.”

One thing, however, is clear:

“Any change should not have any impact on the patients,” she said. “The goal is to provide the best care for the community we can.”

Finding a new vision will have to be team effort, she said, calling on the public, hospitals and other health care providers to get involved.

Notification

The health agency spent Wednesday notifying its some 140 employees and its consumer board about the discussion. Weingartner requested employees be left alone Wednesday to process the information.

Her main message to staff, Weingartner said, was to stay the course.

“We still have people to serve and jobs to do,” she said. “We will continue to provide the great care we have been.”

The Shawnee County Commission on Monday is scheduled to release a memorandum, confirming the county will be looking into options for the health agency’s future.

That day, the commission also is scheduled to sign an extended lease with Stormont-Vail HealthCare for the building at 1615 S.W. 8th Ave.

The county in June 2012 sold the building for $3 million, agreeing to a two-year, rent-free lease to give the main clinic time to relocate. That effort was stalled pending the release of the Safety Net Report, county counselor Rich Eckert said.

“We wanted to be responsible stewards and not enter into hasty real estate transactions ahead of that report coming out,” he said.

Stormont-Vale has agreed to lease the space for $9.50 per square foot each year. The building is 25,681 square feet, or $243,969.50 per year.

The extended lease will allow the county to maintain the status quo until a decision is made, Eckert said. In the meantime, the county will try to find space for the Local Health Department functions. The LHD, in contrast to the primary care services, focuses on broader, population-based health initiatives. It also employes about 70 people, Weingartner said.

The LHD would require between 25,000 and 30,000 square feet, and, Eckert said, the county is “close to closure” on finding that space.

The report

The Safety Net Report repeatedly identifies the county’s current model as ineffective and unsuccessful — and has the statistics to back that up.

Shawnee County, the report found, has a significant gap between need and coverage for the uninsured, yet has the highest costs per patient compared to national and state benchmarks as well as eight comparative cities.

Shawnee County has an estimated 19,958 uninsured adults. Between the health agency, the Marian Clinic, HealthAccess and Valeo Behavioral Health, only 4,098 of those are served.

That means some 15,860 of the county’s uninsured don’t have regular source for medical, dental and/or behavioral health. Of those, the report notes, 8,720 are below 200 percent of the poverty line.

The shortfall can’t fully be explained, the report states, adding that some individuals might get care through other area, such as the criminal justice system.

“However, it is probable that most of these individuals are not receiving regular care, and over time may seek uncompensated care in hospital emergency departments.”

At the same time, Shawnee County’s health agency has a high cost per patient — nearly $800. That is 2.5 times higher than the average FQHC cost in Kansas. The state benchmark is $300, and the national benchmark is $452.

The per patient cost at Marian Clinic is $521.

The report states contributing factors are the patient mix and staffing patterns.

The county’s FQHC, with 5,839 patients, has more than 10 full time enabling staff services. Another Kansas FQHC, the report notes, has 4.14 enabling services staff for 29,317 patients.

Shawnee County saw about 1.51 patients per hour in the first quarter of last year, compared to an internal goal of 1.94 patients per hour.

“This also raises concerns about productivity,” the report states.

Models

The public-entity model creates its own series of challenges, both the report and Weingartner acknowledged.

“It’s just more complex,” she said. “Things need to change more quickly in the health care world right now. Flexibility can be a positive.”

The report further identifies some of those issues, noting the agency has a complex billing system and is limited in hiring top performers by county budgetary restraints. Two county commissioners, it notes, cited budget issues as “creating the greatest conflict of responsibility.”

Under the public entity model, Shawnee County’s health agency serves two boards: The county commission and a consumer board. That is a challenge, the Safety Net Report states, because “these entities sometimes have conflicting agendas.”

As a nonprofit, the county health agency would have increased autonomy and flexibility and protect it from shifts in political circumstances, the report states.

If it decides to pursue the non-profit sector, the health agency could separate and form its own entity, or it could be absorbed into another, existing non-profit. Another possibility as nonprofit would be to work as a private contractor for the county, so it still could receive county funds.

One of the main challenges in changing over to a private nonprofit is transitioning employees out of the public sector, including retirement and other benefits associated with public employment. The transition also will require financial negotiations, ownership of buildings and ongoing subsidies.

The change “may be difficult,” the report states, but others have been able to navigate it successfully.